Nure 3366 - Disorders of the intestines

What is Colorectal cancer?

almost always arises from a pre-existing benign neoplasm, usually in the form of a polyp (stalk-like growth on the wall of the colon) which becomes malignant

How do you diagnose and treat Colorectal cancer?

diagnosis - most often by colonoscopy

Treatment

• if confined to a polyp, a simple polypectomy during the colonoscopy will cure it

• if more widespread, tx will include colectomy (removal of part of colon) & sometimes colostomy (opening created in abdomen for stool); chemothx.

• best tx—prevention! --high-fiber diet, lifestyle changes

What is Inflammatory bowel disease (IBD)?

chronic disorder characterized by inflammation of the lining and walls of the intestines

• Crohn’s disease & ulcerative colitis

• fistula formation --abnormal channels or tracts that develops in

  the presence of inflammation and infection

What is Crohn’s disease?

ALL layers of bowel are involved—ie, entire wall -- transmural

• random segments of inflamed tissue are separated by normal tissue

  ie, Crohn’s has a “patchy” pattern

What are the S&S of Crohn’s disease?

malabsorption, malnutrition, weight loss

• since most nutrients are absorbed in small intestines, especially duodenum

What is Ulcerative colitis?

found only in colon - severe inflammation and ulcerations begin in the rectum & progress to involve entire colon

• areas are confluent, not patchy inflammation and ulcerations are usually

  not transmural—do not extend beyond submucosa

What are the S&S of Ulcerative colitis?

dehydration risk more severe in ulcerative colitis

• because colon is usually the site of main water reabsorption by body

What is Intestinal obstruction?

an occlusion of either the small or large intestine that can be partial or complete in nature

What are the pathogenesis/S&S of Intestinal obstruction?

obstruction → collection of gas and fluid proximal to (above) the obstruction → abdominal distention (becomes swollen/stretched) →

causes following S&S:

• severe, colicky abdominal cramping

• N &V

• can have either constipation or, with partial obstruction, sometimes can have diarrhea

What are the etiology of Intestinal obstruction?

• adhesions—scar tissue from surgery or from a chronic inflammation such as IBD

• hernia-- intestine protrudes through a weakness in the abdominal muscle or through the inguinal ring

• intussusception-- telescoping of one portion of the bowel into the other,

  causing strangulation of blood supply; more common in infants

• volvulus, AKA torsion -- twisting of the intestine with occlusion of blood

  supply.

• paralytic ileus (AKA just “ileus”)-- loss of peristaltic motor activity in the

  intestine

What is Diverticular disease?

herniations or saclike outpouchings of mucosa from the muscle layer of the intestine that protrude from the intestine

• most commonly occur in the sigmoid colon

What is Diverticulosis?

asymptomatic diverticular disease

What is Diverticulitis

inflammation / infection of the diverticula.

• S&S: pain-- most often LLQ pain; fever; leukocytosis

• tx: increase dietary fiber, avoid certain foods (seeds, nuts)

What is Appendicitis?

inflammation most often caused by fecal matter getting caught in lumen of appendix

• treatment is appendectomy

What are the S&S of Appendicitis?

• epigastric or periumbilical pain that then migrates to become RLQ pain.

• like many inflammatory problems, pain is exacerbated upon movement (patient wants to hold very still)

• “rebound” tenderness sometimes present